5% albumin should not be used routinely because there is no evidence that it improves patient important outcomes (e.g., mortality, renal failure) in most clinical situations and is associated with potential harms, including pulmonary edema and fluid overload, as highlighted in the recent ICTMG 2024 albumin guidelines. Its primary indications are as replacement fluid for patients undergoing therapeutic apheresis or in patients with large thermal injuries, consistent with the American Burn Association Clinical Practice Guidelines.
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Callum J, et al. Use of intravenous albumin: a guideline from the International Collaboration for Transfusion Medicine Guidelines. Chest. 2024 Aug;166(2):321-338. Epub 2024 Mar 4. PMID: 38447639.
Cartotto R, et al. American Burn Association clinical practice guidelines on burn shock resuscitation. J Burn Care Res. 2024 May;45(3):565–589. PMID: 38051821.
Connelly-Smith L, et al. Guidelines on the use of therapeutic apheresis in clinical practice: evidence-based approach from the writing committee of the American Society for Apheresis: the ninth special issue. J Clin Apher. 2023 Apr;38(2):77–278. PMID: 37017433.
Relke N, et al. Albumin. In A. Khandelwal & K. Brooks (Eds.), Clinical guide to transfusion (Chap. 3). Canadian Blood Services. [Internet]. 2025 [cited 2025].